Provider Demographics
NPI:1558790725
Name:TRINITY REHAB BRICK
Entity Type:Organization
Organization Name:TRINITY REHAB BRICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVRIELIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-219-5700
Mailing Address - Street 1:150 CHAMBERSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-3491
Mailing Address - Country:US
Mailing Address - Phone:732-219-5700
Mailing Address - Fax:732-219-5703
Practice Address - Street 1:558 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5066
Practice Address - Country:US
Practice Address - Phone:732-219-5700
Practice Address - Fax:732-219-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00303100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty